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Charlton C, Rodrigues AM. How do young women approaching screening age interpret the NHS cervical screening leaflet? A mixed methods study of identifying interpretation difficulties, barriers, facilitators, and leaflet interpretation, engagement and future screening behaviour. Health Psychol Behav Med 2024; 12:2361005. [PMID: 38831975 PMCID: PMC11146246 DOI: 10.1080/21642850.2024.2361005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Cervical cancer is a common cancer among young women aged 25-29 in England, and the NHS cervical screening leaflet is the first point of contact for those being invited for their first screening. This study aimed to explore how young women (18-24) understand and engage with the leaflet, as well as the barriers and facilitators associated with its interpretation, engagement, and screening intentions. METHODS The study used a mixed-methods approach, including a survey (n = 120) to identify interpretation difficulties and how they were affected by different characteristics, and a follow-up interview (n = 10) to assess the utility of the leaflet, identify issues with its practicality, and determine the factors that influence screening intentions. RESULTS The survey results showed that interpretation difficulties were common, particularly regarding HPV assessment, screening results, additional tests/treatment, and screening risks. Lower interpretation accuracy was associated with lower numeracy scores and non-white ethnicity. Despite these difficulties, participants had high confidence and motivation to engage with the leaflet. The interviews revealed knowledge gaps, issues with the leaflet's practicality, and a preference for digital information. Factors that were identified as barriers and facilitators of leaflet interpretation, engagement, and screening intentions included knowledge, social influence, beliefs about consequences, environmental context and resources, social role and identity, emotions and intentions. CONCLUSION The current leaflet does not provide enough information for young women to make an informed decision about screening attendance. Implementing a digital invitation featuring simplified gist representation, targeted behaviour change techniques (BCTs), videos, and interactive tools can enhance education and promote screening behaviour. Future research should consider using digital tools and strategies to address existing barriers related to interpretation and engagement.
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Affiliation(s)
- Caroline Charlton
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
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Travis E, Ashley L, O'Connor DB. Effects of a modified invitation letter to follow-up colonoscopy for bowel cancer detection. Br J Health Psychol 2024; 29:379-394. [PMID: 37953726 DOI: 10.1111/bjhp.12704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 10/10/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE To investigate whether modifications made to the current National Health Service (NHS) invitation letter for follow-up colonoscopy examination affect participant state anxiety and behavioural intentions to attend. METHODS Five hundred and thirty-eight adults of bowel cancer-eligible screening age (56-74) were randomized to receive the current NHS invitation letter or the modified version of the letter as a hypothetical scenario. Modifications to the letter included fewer uses of the term cancer and awareness of alternative screening options. The history of the colonoscopy invitation, anticipated state anxiety, behavioural intention to attend the nurse appointment, and colonoscopy concerns upon reading the letter were measured. RESULTS Behavioural intentions were high in both conditions; however, participants reading the current letter reported significantly higher behavioural intentions compared to the modified letter. There was no main effect of previous invite status or interaction between previous invite status and letter condition on behavioural intentions. However, the effect of the letter on levels of anxiety depended on the participant's invitation history. Those never invited for a colonoscopy were more anxious when reading the modified letter compared to the current letter. Conversely, previous colonoscopy invitees were less anxious following reading the modified letter than those reading the current letter. Those never invited for a colonoscopy were more concerned about embarrassment and test invasiveness. All findings remained the same when controlling for age and education. CONCLUSION Modifications to the invitation letter were not beneficial to levels of screening intention or anxiety.
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Affiliation(s)
| | - Laura Ashley
- School of Humanities & Social Sciences, Leeds Beckett University, Leeds, UK
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Giordano A, De Panfilis L, Veronese S, Bruzzone M, Cascioli M, Farinotti M, Giovannetti AM, Grasso MG, Kruger P, Lugaresi A, Manson L, Perin M, Pucci E, Solaro C, Ghirotto L, Solari A. User appraisal of a booklet for advance care planning in multiple sclerosis: a multicenter, qualitative Italian study. Neurol Sci 2024; 45:1145-1154. [PMID: 37816932 PMCID: PMC10858142 DOI: 10.1007/s10072-023-07087-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVES Implementation of advance care planning (ACP) in people with progressive multiple sclerosis (PwPMS) is limited. We aimed to involve users (PwPMS, significant others, and healthcare professionals involved in PwPMS care) in the evaluation and refinement of a booklet to be used during the ACP conversations. METHODS This qualitative study consisted of cognitive interviews with PwPMS and significant others and a focus group with healthcare professionals from three Italian centers. We analyzed the interviews using the framework method and the focus group using thematic analysis. RESULTS We interviewed 10 PwPMS (3 women; median age 54 years; median Expanded Disability Status Scale score 6.0) and three significant others (2 women; 2 spouses and one daughter). The analysis yielded three themes: booklet comprehensibility and clarity, content acceptability and emotional impact, and suggestions for improvement. Twelve healthcare professionals (7 neurologists, 3 psychologists, one nurse, and one physiotherapist) participated in the focus group, whose analysis identified two themes: booklet's content importance and clarity and challenges to ACP implementation. Based on analysis results, we revised the booklet (text, layout, and pictures) and held a second-round interviews with two PwPMS and one significant other. The interviewees agreed on the revisions but reaffirmed their difficulty in dealing with the topic and the need for a physician when using the booklet. CONCLUSIONS Appraisal of the booklet was instrumental in improving its acceptability and understandability before using it in the ConCure-SM feasibility trial. Furthermore, our data reveal a lack of familiarity with ACP practice in the Italian context.
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Affiliation(s)
- Andrea Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Ludovica De Panfilis
- Bioethics Unit - Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, 42100, Reggio Emilia, Italy
| | | | | | - Marta Cascioli
- Hospice 'La Torre Sul Colle, Azienda USL Umbria 2, 06049, Spoleto, Italy
| | - Mariangela Farinotti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Ambra Mara Giovannetti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | | | - Paola Kruger
- The European Patients' Academy (EUPATI), 00165, Rome, Italy
| | - Alessandra Lugaresi
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40121, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, 40121, Bologna, Italy
| | - Leigh Manson
- Health Quality & Safety Commission New Zealand, 7045, Nelson, New Zealand
| | - Marta Perin
- Bioethics Unit - Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, 42100, Reggio Emilia, Italy
- Doctoral Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41100, Modena, Italy
| | - Eugenio Pucci
- UOC Neurologia AV4, ASUR Marche, 63900, Fermo, Italy
| | - Claudio Solaro
- Department of Rehabilitation, CRRF "Mons. L. Novarese", Loc. Trompone, 13040, Moncrivello, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia, 42100, Reggio Emilia, Italy
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
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McDonald S, Wallis K, Horowitz M, Mann E, Le V, Donald M. Acceptability and optimisation of resources to support antidepressant cessation: a qualitative think-aloud study with patients in Australian primary care. Br J Gen Pract 2024; 74:e113-e119. [PMID: 38272680 PMCID: PMC10714746 DOI: 10.3399/bjgp.2023.0269] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/10/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Stopping long-term (>12 months) antidepressant use can be difficult due to unpleasant withdrawal symptoms. Many people do not recognise withdrawal symptoms or understand how to minimise them while safely discontinuing antidepressants. To address the gaps, the authors developed the 'Redressing long-term antidepressant use' (RELEASE) resources, comprising a medicines information brochure, a decision aid, and drug- specific hyperbolic tapering protocols. AIM To explore patients' acceptability of the RELEASE resources to optimise their use and impact. DESIGN AND SETTING A think-aloud interview study among adults with lived experience of long-term antidepressant use conducted in south-east Queensland, Australia, between November 2021 and June 2022. METHOD Participants were purposively sampled from general practices and interviewed face-to-face or via videoconferencing. Participants verbalised their thoughts, impressions, and feelings while engaging with each resource. Interviews were analysed using a deductive coding framework, including codes related to acceptability and optimisation. Interviews were analysed in a series of four tranches, with iterative modifications made to resources after each tranche. RESULTS Participants (n = 14) reported the resources to be relevant, informative, motivational, and usable. Participants' comments informed modifications, including changes to wording, content order, and layout. Several participants expressed frustration that they had not had these resources earlier, with one reporting the information could have been 'life changing'. Many commented on the need for these resources to be widely available to both patients and doctors. CONCLUSION The RELEASE resources were found to be acceptable, useful, and potentially life changing. The effectiveness of these consumer-informed resources in supporting safe cessation of long-term antidepressants is currently being tested in general practice.
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Affiliation(s)
- Suzanne McDonald
- General Practice Clinical Unit, Medical School, University of Queensland, Brisbane, Australia
| | - Katharine Wallis
- General Practice Clinical Unit, Medical School, University of Queensland, Brisbane, Australia
| | - Mark Horowitz
- Research and Development Department, North East London NHS Foundation Trust, London, UK
| | - Esther Mann
- University of Queensland, Brisbane, Australia
| | - Vilany Le
- University of Queensland, Brisbane, Australia
| | - Maria Donald
- General Practice Clinical Unit, Medical School, University of Queensland, Brisbane, Australia
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Casillan A, Florido ME, Galarza-Cornejo J, Bakken S, Lynch JA, Chung WK, Mittendorf KF, Berner ES, Connolly JJ, Weng C, Holm IA, Khan A, Kiryluk K, Limdi NA, Petukhova L, Sabatello M, Wynn J. Participant-guided development of bilingual genomic educational infographics for Electronic Medical Records and Genomics Phase IV study. J Am Med Inform Assoc 2024; 31:306-316. [PMID: 37860921 PMCID: PMC10797276 DOI: 10.1093/jamia/ocad207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/11/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVE Developing targeted, culturally competent educational materials is critical for participant understanding of engagement in a large genomic study that uses computational pipelines to produce genome-informed risk assessments. MATERIALS AND METHODS Guided by the Smerecnik framework that theorizes understanding of multifactorial genetic disease through 3 knowledge types, we developed English and Spanish infographics for individuals enrolled in the Electronic Medical Records and Genomics Network. Infographics were developed to explain concepts in lay language and visualizations. We conducted iterative sessions using a modified "think-aloud" process with 10 participants (6 English, 4 Spanish-speaking) to explore comprehension of and attitudes towards the infographics. RESULTS We found that all but one participant had "awareness knowledge" of genetic disease risk factors upon viewing the infographics. Many participants had difficulty with "how-to" knowledge of applying genetic risk factors to specific monogenic and polygenic risks. Participant attitudes towards the iteratively-refined infographics indicated that design saturation was reached. DISCUSSION There were several elements that contributed to the participants' comprehension (or misunderstanding) of the infographics. Visualization and iconography techniques best resonated with those who could draw on prior experiences or knowledge and were absent in those without. Limited graphicacy interfered with the understanding of absolute and relative risks when presented in graph format. Notably, narrative and storytelling theory that informed the creation of a vignette infographic was most accessible to all participants. CONCLUSION Engagement with the intended audience who can identify strengths and points for improvement of the intervention is necessary to the development of effective infographics.
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Affiliation(s)
- Aimiel Casillan
- Genetic Counseling Graduate Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, United States
| | - Michelle E Florido
- Genetic Counseling Graduate Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, United States
- Department of Genetics and Development, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, United States
| | - Jamie Galarza-Cornejo
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Suzanne Bakken
- Department of Nursing Scholarship and Research, School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - John A Lynch
- Department of Communication, School of Communication, Film, and Media Studies, University of Cincinnati, Cincinnati, OH 45221, United States
| | - Wendy K Chung
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Kathleen F Mittendorf
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Eta S Berner
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL 35294, United States
| | - John J Connolly
- Center for Applied Genomics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, United States
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Ingrid A Holm
- Division of Genetics and Genomics and Manton Center for Orphan Diseases Research, Boston Children’s Hospital, Boston, MA 02115, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, United States
| | - Atlas Khan
- Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, United States
- Department of Medicine, Division of Nephrology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, United States
| | - Krzysztof Kiryluk
- Department of Medicine, Division of Nephrology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, United States
| | - Nita A Limdi
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, United States
| | - Lynn Petukhova
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY 10032, United States
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Maya Sabatello
- Department of Medicine, Center for Precision Medicine and Genomics, Columbia University Irving Medical Center, New York, NY 10032, United States
- Department of Medical Humanities and Ethics, Division of Ethics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Julia Wynn
- Genetic Counseling Graduate Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, United States
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, United States
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Jallow M, Black G, van Os S, Baldwin DR, Brain KE, Donnelly M, Janes SM, Kurtidu C, McCutchan G, Robb KA, Ruparel M, Quaife SL. Acceptability of a standalone written leaflet for the National Health Service for England Targeted Lung Health Check Programme: A concurrent, think-aloud study. Health Expect 2022; 25:1776-1788. [PMID: 35475542 PMCID: PMC9327842 DOI: 10.1111/hex.13520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Many countries are introducing low-dose computed tomography screening programmes for people at high risk of lung cancer. Effective communication strategies that convey risks and benefits, including unfamiliar concepts and outcome probabilities based on population risk, are critical to achieving informed choice and mitigating inequalities in uptake. METHODS This study investigated the acceptability of an aspect of NHS England's communication strategy in the form of a leaflet that was used to invite and inform eligible adults about the Targeted Lung Health Check (TLHC) programme. Acceptability was assessed in terms of how individuals engaged with, comprehended and responded to the leaflet. Semi-structured, 'think aloud' interviews were conducted remotely with 40 UK screening-naïve current and former smokers (aged 55-73). The verbatim transcripts were analysed thematically using a coding framework based on the Dual Process Theory of cognition. RESULTS The leaflet helped participants understand the principles and procedures of screening and fostered cautiously favourable intentions. Three themes captured the main results of the data analysis: (1) Response-participants experienced anxiety about screening results and further investigations, but the involvement of specialist healthcare professionals was reassuring; (2) Engagement-participants were rapidly drawn to information about lung cancer prevalence, and benefits of screening, but deliberated slowly about early diagnosis, risks of screening and less familiar symptoms of lung cancer; (3) Comprehension-participants understood the main principles of the TLHC programme, but some were confused by its rationale and eligibility criteria. Radiation risks, abnormal screening results and numerical probabilities of screening outcomes were hard to understand. CONCLUSION The TLHC information leaflet appeared to be acceptable to the target population. There is scope to improve aspects of comprehension and engagement in ways that would support informed choice as a distributed process in lung cancer screening. PATIENT OR PUBLIC CONTRIBUTION The insight and perspectives of patient representatives directly informed and improved the design and conduct of this study.
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Affiliation(s)
- Mbasan Jallow
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Georgia Black
- Department of Applied Health ResearchUniversity College LondonLondonUK
| | - Sandra van Os
- Department of Applied Health ResearchUniversity College LondonLondonUK
| | - David R. Baldwin
- Department of Respiratory MedicineNottingham University Hospitals NHS Trust, City HospitalNottinghamUK
| | - Kate E. Brain
- Division of Population MedicineCardiff UniversityCardiffUK
| | | | - Samuel M. Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of MedicineUniversity College LondonLondonUK
| | - Clara Kurtidu
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | | | - Kathryn A. Robb
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, Division of MedicineUniversity College LondonLondonUK
| | - Samantha L. Quaife
- Wolfson Institute of Population Health, Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
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Travis E, Ashley L, Pownall M, O'Connor DB. Barriers to flexible sigmoidoscopy colorectal cancer screening in low uptake socio-demographic groups: A systematic review. Psychooncology 2020; 29:1237-1247. [PMID: 32539187 DOI: 10.1002/pon.5443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To synthesise qualitative evidence related to barriers and facilitators of flexible sigmoidoscopy screening (FSS) intention and uptake, particularly within low socio-demographic uptake groups. FSS uptake is lower amongst women, lower socio-economic status (SES), and Asian ethnic groups within the United Kingdom (UK) and United States of America. METHODS A total of 12 168 articles were identified from searches of four databases: EMBASE, MEDLINE, PsycINFO and Web of Science. Eligibility criteria included: individuals eligible to attend FSS and empirical peer-reviewed studies that analysed qualitative data. The Critical Appraisal Skills Program tool evaluated the methodological quality of included studies, and thematic synthesis was used to analyse the data. RESULTS Ten qualitative studies met the inclusion criteria. Key barriers to FSS intention and uptake centred upon procedural anxieties. Women, including UK Asian women, reported shame and embarrassment, anticipated pain, perforation risk, and test preparation difficulties to elevate anxiety levels. Religious and cultural-influenced health beliefs amongst UK Asian groups were reported to inhibit FSS intention and uptake. Competing priorities, such as caring commitments, particularly impeded women's ability to attend certain FSS appointments. The review identified a knowledge gap concerning factors especially associated with FSS participation amongst lower SES groups. CONCLUSIONS Studies mostly focussed on barriers and facilitators of intention to participate in FSS, particularly within UK Asian groups. To determine the barriers associated with FSS uptake, and further understand how screening intention translates to behaviour, it is important that future qualitative research is equally directed towards factors associated with screening behaviour.
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Affiliation(s)
| | - Laura Ashley
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, UK
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Visualizations of Projected Rainfall Change in the United Kingdom: An Interview Study about User Perceptions. SUSTAINABILITY 2020. [DOI: 10.3390/su12072955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stakeholders from public, private, and third sectors need to adapt to a changing climate. Communications about climate may be challenging, especially for audiences with limited climate expertise. Here, we study how such audience members perceive visualizations about projected future rainfall. In semi-structured interviews, we presented 24 participants from climate-conscious organizations across the UK with three prototypical visualizations about projected future rainfall, adopted from the probabilistic United Kingdom Climate Projections: (1) Maps displaying a central estimate and confidence intervals, (2) a line graph and boxplots displaying change over time and associated confidence intervals, and (3) a probability density function for distributions of rainfall change. We analyzed participants’ responses using “Thematic Analysis”. In our analysis, we identified features that facilitated understanding—such as colors, simple captions, and comparisons between different emission scenarios—and barriers that hindered understanding, such as unfamiliar acronyms and terminology, confusing usage of probabilistic estimates, and expressions of relative change in percentages. We integrate these findings with the interdisciplinary risk communication literature and suggest content-related and editorial strategies for effectively designing visualizations about uncertain climate projections for audiences with limited climate expertise. These strategies will help organizations such as National Met Services to effectively communicate about a changing climate.
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Douma LN, Uiters E, Timmermans DRM. Decision-making styles in the context of colorectal cancer screening. BMC Psychol 2020; 8:11. [PMID: 32014059 PMCID: PMC6998095 DOI: 10.1186/s40359-020-0381-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 01/26/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Our study examined the use of decision-making styles, as identified by Scott and Bruce (1995) (i.e. differentiating between a rational, intuitive, dependent, avoidant and spontaneous decision-making style), within the context of colorectal cancer (CRC) screening participation. In the field of cancer screening, informed decision-making is considered important, which follows the Rational Decision model. Subsequently, gaining more insight into decision-making styles being used in real life, could improve support to people when making their screening decision. In addition, we examined whether the decision-making style that people used was associated with their experienced decisional conflict. METHODS An online survey was carried out among a sample of first-time CRC screening invitees (1282 respondents, response rate 49%). We assessed people's decision-making styles, CRC screening participation, education level, self-reported health literacy, and decisional conflict, and examined the possible associations between them. RESULTS In our study, people who had to decide about CRC screening scored high on using both a rational and intuitive decision-making style. Respondents scoring higher on using a spontaneous or dependent decision-making style were more likely to have participated in CRC screening, while respondents scoring higher on using an avoidant decision-making style were more likely not to have participated in CRC screening. However, differences were small. Generally, people in our study experienced low decisional conflict. CONCLUSION Our eligible CRC screening population scored high on using both a rational and intuitive decision-making style. To optimise support to people, public education materials could be appealing more to the intuitive processes at hand. That being said, the current education materials aimed at informed/rational decision-making do not necessarily seem to create a problem, as people generally experienced low decisional conflict. Possible concerns regarding the use of a spontaneous, dependent or avoidant decision-making style could be that these styles might be contributing to less informed decisions. However, it is relevant to consider that the found differences are small and that any possible concern applies to a relatively small group of people.
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Affiliation(s)
- Linda N. Douma
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Postbus 1, 3720 BA Bilthoven, The Netherlands
| | - Ellen Uiters
- National Institute for Public Health and the Environment (RIVM), Postbus 1, 3720 BA Bilthoven, The Netherlands
| | - Danielle R. M. Timmermans
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Postbus 1, 3720 BA Bilthoven, The Netherlands
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Okan Y, Petrova D, Smith SG, Lesic V, Bruine de Bruin W. How Do Women Interpret the NHS Information Leaflet about Cervical Cancer Screening? Med Decis Making 2019; 39:738-754. [PMID: 31556840 PMCID: PMC6843617 DOI: 10.1177/0272989x19873647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/17/2019] [Indexed: 11/16/2022]
Abstract
Background. Organized screening programs often rely on written materials to inform the public. In the United Kingdom, women invited for cervical cancer screening receive a leaflet from the National Health Service (NHS) to support screening decisions. However, information about screening may be too complex for people to understand, potentially hindering informed decision making. Objectives. We aimed to identify women's difficulties in interpreting the leaflet used in England and negative and positive responses to the leaflet. Methods. We used a sequential mixed-methods design involving 2 steps: cognitive think-aloud interviews (n = 20), followed by an England-wide survey (n = 602). Data were collected between June 2017 and December 2018, and participants included women aged 25 to 64 y with varying sociodemographics. Results. Interview results revealed misunderstandings concerning screening results, benefits, and additional tests and treatment, although participants tended to react positively to numerical information. Participants were often unfamiliar with the potential harms associated with screening (i.e., screening risks), key aspects of human papillomavirus, and complex terms (e.g., dyskaryosis). Survey results indicated that interpretation difficulties were common (M correct items = 12.5 of 23). Lower understanding was associated with lower educational level (β's >0.15, P's <0.001), lower numeracy scores (β = 0.36, P < 0.001), and nonwhite ethnicity (β = 0.10, P = 0.007). The leaflet was evaluated positively overall. Conclusions. Despite previous user testing of the leaflet, key information may be too complex for some recipients. As a consequence, they may struggle to make informed decisions about screening participation based on the information provided. We discuss implications for the improvement of communications about screening and decision support.
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Affiliation(s)
- Yasmina Okan
- Centre for Decision Research, Leeds University Business School, University of Leeds, Leeds, UK
| | - Dafina Petrova
- />Cancer Registry of Granada, Andalusian School of Public Health, Granada, Spain
- />Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), University of Granada, Spain
- />CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Vedran Lesic
- Centre for Decision Research, Leeds University Business School, University of Leeds, Leeds, UK
| | - Wändi Bruine de Bruin
- />Centre for Decision Research, Leeds University Business School, University of Leeds, Leeds, UK
- />Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA
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Stoffel S, Benito L, Milà N, Travier N, Binefa G, Vidal C, Espinosa J, Moreno V, Garcia M. Testing behavioral interventions to optimize participation in a population-based colorectal cancer screening program in Catalonia, Spain. Prev Med 2019; 119:58-62. [PMID: 30594532 DOI: 10.1016/j.ypmed.2018.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 12/08/2018] [Accepted: 12/24/2018] [Indexed: 10/27/2022]
Abstract
The aim of the study was to measure the effect of three cost-neutral behavioral interventions on participation compared to the standard invitation letter in a population-based colorectal cancer screening program in 2014. For that purpose, a four-arm randomized field trial was conducted among 5077 individuals aged 50 to 69 years. Over an 8-week period, each week was randomly allocated to the intervention or the control conditions. Individuals assigned to the intervention conditions additionally received a prompt to write down the date to pick up the screening test in a pharmacy. Two of the three intervention groups also included an additional paragraph in the invitation letter on either: 1) the high proportion of individuals participating regularly (social norms condition) or 2) the importance of regular participation (benefit condition). We measured screening participation before and after receiving a reminder letter six weeks after the screening invitation. An overall 8.0 percentage point increase in CRC screening was achieved as a direct result of receiving a reminder letter; however none of the intervention strategies influenced participation. The only significant difference was found for newly invited individuals. There, participation rates decreased from 34.9% to 24.2% when the invitation mailing mentioned the importance of regular participation (OR: 0.60; 95% CI: 0.38-0.95). While none of the intervention strategies improved participation rates we found that praising the benefit of regular screening may discourage individuals who have never been invited before as the continuous behavior may be perceived as a large request. Nevertheless, the reminder letter boosted participation rates independently of the intervention assigned.
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Affiliation(s)
- S Stoffel
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - L Benito
- Department of Fundamental Care and Medical-Surgical Nursing, University of Barcelona, L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - N Milà
- Cancer Prevention and Control Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBEResp), 28029 Madrid, Spain
| | - N Travier
- Cancer Prevention and Control Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - G Binefa
- Cancer Prevention and Control Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - C Vidal
- Cancer Prevention and Control Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - J Espinosa
- Cancer Prevention and Control Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - V Moreno
- Cancer Prevention and Control Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - M Garcia
- Cancer Prevention and Control Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, 08908 Barcelona, Spain.
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Wilson C, Flight I, Zajac IT, Turnbull D, Young GP, Olver I. Web-Based Communication Strategies Designed to Improve Intention to Minimize Risk for Colorectal Cancer: Randomized Controlled Trial. JMIR Cancer 2018; 4:e2. [PMID: 29434013 PMCID: PMC5826979 DOI: 10.2196/cancer.8250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 12/05/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND People seek information on the Web for managing their colorectal cancer (CRC) risk but retrieve much personally irrelevant material. Targeting information pertinent to this cohort via a frequently asked question (FAQ) format could improve outcomes. OBJECTIVE We identified and prioritized colorectal cancer information for men and women aged 35 to 74 years (study 1) and built a website containing FAQs ordered by age and gender. In study 2, we conducted a randomized controlled trial (RCT) to test whether targeted FAQs were more influential on intention to act on CRC risk than the same information accessed via a generic topic list. Secondary analyses compared preference for information delivery, usability, relevance, and likelihood of recommendation of FAQ and LIST websites. METHODS Study 1 determined the colorectal cancer information needs of Australians (N=600) by sex and age group (35-49, 50-59, 60-74) through a Web-based survey. Free-text responses were categorized as FAQs: the top 5 issues within each of the 6 cohorts were identified. Study 2 (N=240) compared the impact of presentation as targeted FAQ links to information with links presented as a generic list (LIST) and a CONTROL (no information) condition. We also tested preference for presentation of access to information as FAQ or LIST by adding a CHOICE condition (a self-selected choice of FAQs or a list of information topics). RESULTS Study 1 showed considerable consistency in information priorities among all 6 cohorts with 2 main concerns: treatment of CRC and risk factors. Some differences included a focus on general risk factors, excluding diet and lifestyle, in the younger cohort, and on the existence of a test for CRC in the older cohorts. Study 2 demonstrated that, although respondents preferred information access ordered by FAQs over a list, presentation in this format had limited impact on readiness to act on colorectal cancer risk compared with the list or a no-information control (P=.06). Both FAQ and LIST were evaluated as equally usable. Those aged 35 to 49 years rated the information less relevant to them and others in their age group, and information ordered by FAQs was rated, across all age groups and both sexes, as less relevant to people outside the age group targeted within the FAQs. CONCLUSIONS FAQs are preferred over a list as a strategy for presenting access to information about CRC. They may improve intention to act on risk, although further research is required. Future research should aim to identify better the characteristics of information content and presentation that optimize perceived relevance and fully engage the target audience. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12618000137291; https://www.anzctr.org. au/Trial/Registration/TrialReview.aspx?id=374129 (Archived by WebCite at http://www.webcitation.org/6x2Mr6rPC).
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Affiliation(s)
- Carlene Wilson
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.,La Trobe University, Heidelberg, VIC, Australia.,Olivia Newton John Cancer Wellness & Research Centre, Austin Hospital, Heidelberg, VIC, Australia
| | - Ingrid Flight
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Ian T Zajac
- Health & Biosecurity, Commonwealth Scientific & Industrial Research Organisation, Adelaide, SA, Australia
| | - Deborah Turnbull
- Freemasons Foundation Centre for Men's Health, School of Psychology, University of Adelaide, Adelaide, SA, Australia
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Ian Olver
- Sansom Institute for Health Research, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
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13
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Nekolaichuk C, Huot A, Gratton V, Bush SH, Tarumi Y, Watanabe SM. Development of a French Version of the Edmonton Symptom Assessment System-Revised: A Pilot Study of Palliative Care Patients' Perspectives. J Palliat Med 2017; 20:966-976. [DOI: 10.1089/jpm.2016.0510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Cheryl Nekolaichuk
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
- Tertiary Palliative Care Unit, Grey Nuns Community Hospital, Edmonton, Alberta, Canada
- Palliative Institute, Covenant Health, Edmonton, Alberta, Canada
| | - Ann Huot
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
- Department of Symptom Control and Palliative Care, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Valérie Gratton
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Montfort Hospital, Ottawa, Ontario, Canada
| | - Shirley H. Bush
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Palliative Care Unit, Élisabeth Bruyère Hospital, Ottawa, Ontario, Canada
| | - Yoko Tarumi
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
- Palliative Care Consult Service, Royal Alexandria Hospital, Edmonton, Alberta, Canada
| | - Sharon M. Watanabe
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
- Department of Symptom Control and Palliative Care, Cross Cancer Institute, Edmonton, Alberta, Canada
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14
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Smith SG, Wardle J, Atkin W, Raine R, McGregor LM, Vart G, Morris S, Duffy SW, Moss S, Hackshaw A, Halloran S, Kralj-Hans I, Howe R, Snowball J, Handley G, Logan RF, Rainbow S, Smith S, Thomas M, Counsell N, von Wagner C. Reducing the socioeconomic gradient in uptake of the NHS bowel cancer screening Programme using a simplified supplementary information leaflet: a cluster-randomised trial. BMC Cancer 2017; 17:543. [PMID: 28806955 PMCID: PMC5556676 DOI: 10.1186/s12885-017-3512-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/28/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Uptake of colorectal cancer screening is low in the English NHS Bowel Cancer Screening Programme (BCSP). Participation in screening is strongly associated with socioeconomic status. The aim of this study was to determine whether a supplementary leaflet providing the 'gist' of guaiac-based Faecal Occult Blood test (gFOBt) screening for colorectal cancer could reduce the socioeconomic status (SES) gradient in uptake in the English NHS BCSP. METHODS The trial was integrated within routine BCSP operations in November 2012. Using a cluster randomised controlled design all adults aged 59-74 years who were being routinely invited to complete the gFOBt were randomised based on day of invitation. The Index of Multiple Deprivation was used to create SES quintiles. The control group received the standard information booklet ('SI'). The intervention group received the SI booklet and the Gist leaflet ('SI + Gist') which had been designed to help people with lower literacy engage with the invitation. Blinding of hubs was not possible and invited subjects were not made aware of a comparator condition. The primary outcome was the gradient in uptake across IMD quintiles. RESULTS In November 2012, 163,525 individuals were allocated to either the 'SI' intervention (n = 79,104) or the 'SI + Gist' group (n = 84,421). Overall uptake was similar between the intervention and control groups (SI: 57.3% and SI + Gist: 57.6%; OR = 1.02, 95% CI: 0.92-1.13, p = 0.77). Uptake was 42.0% (SI) vs. 43.0% (SI + Gist) in the most deprived quintile and 65.6% vs. 65.8% in the least deprived quintile (interaction p = 0.48). The SES gradient in uptake was similar between the study groups within age, gender, hub and screening round sub-groups. CONCLUSIONS Providing supplementary simplified information in addition to the standard information booklet did not reduce the SES gradient in uptake in the NHS BCSP. The effectiveness of the Gist leaflet when used alone should be explored in future research. TRIAL REGISTRATION ISRCTN74121020 , registered: 17/20/2012.
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Affiliation(s)
- Samuel G. Smith
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9LB UK
| | - Jane Wardle
- Department of Behavioural Science and Health, University College London, London, WC1E 7HB UK
| | - Wendy Atkin
- Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, W2 1NY UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, WC1E 7HB UK
| | - Lesley M. McGregor
- Department of Behavioural Science and Health, University College London, London, WC1E 7HB UK
| | - Gemma Vart
- Department of Behavioural Science and Health, University College London, London, WC1E 7HB UK
- Research & Enterprise Royal Holloway University of London, London, England
| | - Steve Morris
- Department of Applied Health Research, University College London, London, WC1E 7HB UK
| | - Stephen W. Duffy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, EC1M 6BQ UK
| | - Susan Moss
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, EC1M 6BQ UK
| | - Allan Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, WC1E 7HB UK
| | - Stephen Halloran
- Bowel Cancer Screening Southern Programme Hub, Guildford, GU2 7XX UK
| | - Ines Kralj-Hans
- Academic Neuroscience Centre, King’s College London, London, SE5 8AF UK
| | - Rosemary Howe
- Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, W2 1NY UK
| | - Julia Snowball
- Bowel Cancer Screening Southern Programme Hub, Guildford, GU2 7XX UK
| | - Graham Handley
- North East Bowel Cancer Screening Hub, Gateshead, NE9 6SX UK
| | - Richard F. Logan
- Eastern Hub of the Bowel Cancer Screening Programme, Nottingham, NG7 2UH UK
| | - Sandra Rainbow
- Bowel Cancer Screening Programme London Programme Hub, London, HA1 3UJ UK
| | - Steve Smith
- Midlands & North West Bowel Cancer Screening Programme Hub, Rugby, CV22 5PX UK
| | - Mary Thomas
- Department of Applied Health Research, University College London, London, WC1E 7HB UK
| | - Nicholas Counsell
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, WC1E 7HB UK
| | - Christian von Wagner
- Department of Behavioural Science and Health, University College London, London, WC1E 7HB UK
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15
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Hofmann B. Ethical issues with colorectal cancer screening-a systematic review. J Eval Clin Pract 2017; 23:631-641. [PMID: 28026076 DOI: 10.1111/jep.12690] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/16/2016] [Accepted: 11/16/2016] [Indexed: 12/26/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Colorectal cancer (CRC) screening is widely recommended and implemented. However, sometimes CRC screening is not implemented despite good evidence, and some types of CRC screening are implemented despite lack of evidence. The objective of this article is to expose and elucidate relevant ethical issues in the literature on CRC screening that are important for open and transparent deliberation on CRC screening. METHODS An axiological question-based method is used for exposing and elucidating ethical issues relevant in HTA. A literature search in MEDLINE, Embase, PsycINFO, PubMed Bioethics subset, ISI Web of Knowledge, Bioethics Literature Database (BELIT), Ethics in Medicine (ETHMED), SIBIL Base dati di bioetica, LEWI Bibliographic Database on Ethics in the Sciences and Humanities, and EUROETHICS identified 870 references of which 114 were found relevant according to title and abstract. The content of the included papers were subject to ethical analysis to highlight the ethical issues, concerns, and arguments. RESULTS A wide range of important ethical issues were identified. The main benefits are reduced relative CRC mortality rate, and potentially incidence rate, but there is no evidence of reduced absolute mortality rate. Potential harms are bleeding, perforation, false test results, overdetection, overdiagnosis, overtreatment (including unnecessary removal of polyps), and (rarely) death. Other important issues are related to autonomy and informed choice equity, justice, medicalization, and expanding disease. CONCLUSION A series of important ethical issues have been identified and need to be addressed in open and transparent deliberation on CRC screening.
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Affiliation(s)
- Bjørn Hofmann
- Department of Health Science, the Norwegian University for Science and Technology, Gjøvik, Norway.,The Centre of Medical Ethics at the University of Oslo, Norway
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16
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Witteman HO, Presseau J, Nicholas Angl E, Jokhio I, Schwalm JD, Grimshaw JM, Bosiak B, Natarajan MK, Ivers NM. Negotiating Tensions Between Theory and Design in the Development of Mailings for People Recovering From Acute Coronary Syndrome. JMIR Hum Factors 2017; 4:e6. [PMID: 28249831 PMCID: PMC5352859 DOI: 10.2196/humanfactors.6502] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 11/13/2022] Open
Abstract
Background Taking all recommended secondary prevention cardiac medications and fully participating in a formal cardiac rehabilitation program significantly reduces mortality and morbidity in the year following a heart attack. However, many people who have had a heart attack stop taking some or all of their recommended medications prematurely and many do not complete a formal cardiac rehabilitation program. Objective The objective of our study was to develop a user-centered, theory-based, scalable intervention of printed educational materials to encourage and support people who have had a heart attack to use recommended secondary prevention cardiac treatments. Methods Prior to the design process, we conducted theory-based interviews and surveys with patients who had had a heart attack to identify key determinants of secondary prevention behaviors. Our interdisciplinary research team then partnered with a patient advisor and design firm to undertake an iterative, theory-informed, user-centered design process to operationalize techniques to address these determinants. User-centered design requires considering users’ needs, goals, strengths, limitations, context, and intuitive processes; designing prototypes adapted to users accordingly; observing how potential users respond to the prototype; and using those data to refine the design. To accomplish these tasks, we conducted user research to develop personas (archetypes of potential users), developed a preliminary prototype using behavior change theory to map behavior change techniques to identified determinants of medication adherence, and conducted 2 design cycles, testing materials via think-aloud and semistructured interviews with a total of 11 users (10 patients who had experienced a heart attack and 1 caregiver). We recruited participants at a single cardiac clinic using purposive sampling informed by our personas. We recorded sessions with users and extracted key themes from transcripts. We held interdisciplinary team discussions to interpret findings in the context of relevant theory-based evidence and iteratively adapted the intervention accordingly. Results Through our iterative development and testing, we identified 3 key tensions: (1) evidence from theory-based studies versus users’ feelings, (2) informative versus persuasive communication, and (3) logistical constraints for the intervention versus users’ desires or preferences. We addressed these by (1) identifying root causes for users’ feelings and addressing those to better incorporate theory- and evidence-based features, (2) accepting that our intervention was ethically justified in being persuasive, and (3) making changes to the intervention where possible, such as attempting to match imagery in the materials to patients’ self-images. Conclusions Theory-informed interventions must be operationalized in ways that fit with user needs. Tensions between users’ desires or preferences and health care system goals and constraints must be identified and addressed to the greatest extent possible. A cluster randomized controlled trial of the final intervention is currently underway.
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Affiliation(s)
- Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada.,Office of Education and Professional Development, Faculty of Medicine, Laval University, Quebec City, QC, Canada.,Pavillon Ferdinand-Vandry 2881, Quebec City, QC, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Emily Nicholas Angl
- Patients Canada, Toronto, ON, Canada.,Pivot Design Group Inc, Toronto, ON, Canada
| | | | - J D Schwalm
- Department of Medicine, Division of Cardiology, Hamilton Health Sciences, Hamilton, ON, Canada.,Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Beth Bosiak
- Women's College Research Institute, Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Madhu K Natarajan
- Department of Medicine, Division of Cardiology, Hamilton Health Sciences, Hamilton, ON, Canada.,Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Noah M Ivers
- Women's College Research Institute, Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Family Practice Health Centre, Women's College Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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17
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Raine R, Atkin W, von Wagner C, Duffy S, Kralj-Hans I, Hackshaw A, Counsell N, Moss S, McGregor L, Palmer C, Smith SG, Thomas M, Howe R, Vart G, Band R, Halloran SP, Snowball J, Stubbs N, Handley G, Logan R, Rainbow S, Obichere A, Smith S, Morris S, Solmi F, Wardle J. Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BackgroundBowel cancer screening reduces cancer-specific mortality. There is a socioeconomic gradient in the uptake of the English NHS Bowel Cancer Screening Programme (BCSP), which may lead to inequalities in cancer outcomes.ObjectiveTo reduce socioeconomic inequalities in uptake of the NHS BCSP’s guaiac faecal occult blood test (gFOBt) without compromising uptake in any socioeconomic group.DesignWorkstream 1 explored psychosocial determinants of non-uptake of gFOBt in focus groups and interviews. Workstream 2 developed and tested four theoretically based interventions: (1) ‘gist’ information, (2) a ‘narrative’ leaflet, (3) ‘general practice endorsement’ (GPE) and (4) an ‘enhanced reminder’ (ER). Workstream 3 comprised four national cluster randomised controlled trials (RCTs) of the cost-effectiveness of each intervention.MethodsInterventions were co-designed with user panels, user tested using interviews and focus groups, and piloted with postal questionnaires. RCTs compared ‘usual care’ (existing NHS BCSP invitations) with usual care plus each intervention. The four trials tested: (1) ‘gist’ leaflet (n = 163,525), (2) ‘narrative’ leaflet (n = 150,417), (3) GPE on the invitation letter (n = 265,434) and (4) ER (n = 168,480). Randomisation was based on day of mailing of the screening invitation. The Index of Multiple Deprivation (IMD) score associated with each individual’s home address was used as the marker of socioeconomic circumstances (SECs). Change in the socioeconomic gradient in uptake (interaction between treatment group and IMD quintile) was the primary outcome. Screening uptake was defined as the return of a gFOBt kit within 18 weeks of the invitation that led to a ‘definitive’ test result of either ‘normal’ (i.e. no further investigation required) or ‘abnormal’ (i.e. requiring referral for further testing). Difference in overall uptake was the secondary outcome.ResultsThe gist and narrative trials showed no effect on the SECs gradient or overall uptake (57.6% and 56.7%, respectively, compared with 57.3% and 58.5%, respectively, for usual care; allp-values > 0.05). GPE showed no effect on the gradient (p = 0.5) but increased overall uptake [58.2% vs. 57.5% in usual care, odds ratio (OR) = 1.07, 95% confidence interval (CI) 1.04 to 1.10;p < 0.0001]. ER showed a significant interaction with SECs (p = 0.005), with a stronger effect in the most deprived IMD quintile (14.1% vs. 13.3% in usual care, OR = 1.11, 95% CI 1.04 to 1.20;p = 0.003) than the least deprived (34.7% vs. 34.9% in usual care OR = 1.00, 95% CI 0.94 to 1.06;p = 0.98), and higher overall uptake (25.8% vs. 25.1% in usual care, OR = 1.07, 95% CI 1.03 to 1.11;p = 0.001). All interventions were inexpensive to provide.LimitationsIn line with NHS policy, the gist and narrative leaflets supplemented rather than replaced existing NHS BCSP information. This may have undermined their effect.ConclusionsEnhanced reminder reduced the gradient and modestly increased overall uptake, whereas GPE increased overall uptake but did not reduce the gradient. Therefore, given their effectiveness and very low cost, the findings suggest that implementation of both by the NHS BCSP would be beneficial. The gist and narrative results highlight the challenge of achieving equitable delivery of the screening offer when all communication is written; the format is universal and informed decision-making mandates extensive medical information.Future workSocioculturally tailored research to promote communication about screening with family and friends should be developed and evaluated.Trial registrationCurrent Controlled Trials ISRCTN74121020.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Wendy Atkin
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Christian von Wagner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Stephen Duffy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Ines Kralj-Hans
- Department of Biostatistics, King’s Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Allan Hackshaw
- University College London Cancer Trials Centre, London, UK
| | | | - Sue Moss
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Lesley McGregor
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Cecily Palmer
- Department of Applied Health Research, University College London, London, UK
| | - Samuel G Smith
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Mary Thomas
- Department of Applied Health Research, University College London, London, UK
| | - Rosemary Howe
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Gemma Vart
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Roger Band
- Patient and Public Involvement Representative, Evesham, UK
| | - Stephen P Halloran
- NHS Bowel Cancer Screening Programme Southern Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Julia Snowball
- NHS Bowel Cancer Screening Programme Southern Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Neil Stubbs
- NHS Bowel Cancer Screening Programme Southern Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Graham Handley
- NHS Bowel Cancer Screening Programme North East Hub, Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, UK
| | - Richard Logan
- NHS Bowel Cancer Screening Programme Eastern Hub, Nottingham University Hospitals, Nottingham, UK
| | - Sandra Rainbow
- NHS Bowel Cancer Screening Programme London Hub, Northwick Park and St Marks Hospitals NHS Trust, Harrow, UK
| | - Austin Obichere
- North Central London Bowel Cancer Screening Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephen Smith
- NHS Bowel Cancer Screening Programme Midlands and North West Hub, University Hospitals Coventry and Warwickshire NHS Trust, Hospital of St Cross, Rugby, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Francesca Solmi
- Department of Applied Health Research, University College London, London, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
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18
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Smith SG, McGregor LM, Raine R, Wardle J, von Wagner C, Robb KA. Inequalities in cancer screening participation: examining differences in perceived benefits and barriers. Psychooncology 2016; 25:1168-1174. [PMID: 27309861 PMCID: PMC5082500 DOI: 10.1002/pon.4195] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Inequalities exist in colorectal cancer (CRC) screening uptake, with people from lower socioeconomic status backgrounds less likely to participate. Identifying the facilitators and barriers to screening uptake is important to addressing screening disparities. We pooled data from 2 trials to examine educational differences in psychological constructs related to guaiac fecal occult blood testing. METHODS Patients (n = 8576) registered at 7 general practices in England, within 15 years of the eligible age range for screening (45-59.5 years), were invited to complete a questionnaire. Measures included perceived barriers (emotional and practical) and benefits of screening, screening intentions, and participant characteristics including education. RESULTS After data pooling, 2181 responses were included. People with high school education or no formal education reported higher emotional and practical barriers and were less likely to definitely intend to participate in screening, compared with university graduates in analyses controlling for study arm and participant characteristics. The belief that one would worry more about CRC after screening and concerns about tempting fate were strongly negatively associated with education. In a model including education and participant characteristics, respondents with low emotional barriers, low practical barriers, and high perceived benefits were more likely to definitely intend to take part in screening. CONCLUSIONS In this analysis of adults approaching the CRC screening age, there was a consistent effect of education on perceived barriers toward guaiac fecal occult blood testing, which could affect screening decision making. Interventions should target specific barriers to reduce educational disparities in screening uptake and avoid exacerbating inequalities in CRC mortality.
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Affiliation(s)
- S G Smith
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
- Department of Epidemiology and Public Health, University College London, London, UK.
| | - L M McGregor
- Department of Epidemiology and Public Health, University College London, London, UK
| | - R Raine
- Department of Applied Health Research, University College London, London, UK
| | - J Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
| | - C von Wagner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - K A Robb
- Department of Epidemiology and Public Health, University College London, London, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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19
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McGregor LM, Skrobanski H, Miller H, Ritchie M, Berkman L, Morris S, Rees C, von Wagner C. Using Specialist Screening Practitioners (SSPs) to increase uptake of the Bowel Scope (Flexible Sigmoidoscopy) Screening Programme: a study protocol for a feasibility single-stage phase II trial. Pilot Feasibility Stud 2016; 2:54. [PMID: 27965871 PMCID: PMC5153869 DOI: 10.1186/s40814-016-0093-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 08/12/2016] [Indexed: 01/22/2023] Open
Abstract
Background The NHS Bowel Scope Screening (BSS) programme offers men and women aged 55 years a once-only flexible sigmoidoscopy (FS), a test that can help reduce colorectal cancer (CRC) incidence and mortality. However, the benefits of BSS are contingent on uptake. This National Institute for Health Research-funded single-stage phase II trial will test the feasibility of using patient navigation (PN), an intervention that offers support to patients to overcome barriers to healthcare, to increase BSS uptake within a socially deprived area of England. Methods/design All individuals invited for BSS at South Tyneside NHS Foundation Trust during the 6-month recruitment period will be invited to take part in the study. Consenting participants will be randomised to receive PN or usual care in a 2:1 ratio. PN involves non-attenders receiving a phone call from a Specialist Screening Practitioner (SSP) who will elicit reasons for non-attendance and offer educational, practical, and emotional support as needed. If requested by the patient, another appointment for BSS will then be arranged. We anticipate 30 % of participants will be non-attenders. Using A’Hern single-stage design, with 20 % significance level and 80 % power, at least 35 participants who receive PN need to subsequently attend for PN to be considered worthy of further investigation in a definitive trial. The primary outcome measure will be the number of participants in the PN group who re-book and attend their BSS appointment. A qualitative analysis of the PN transcripts, and interviews with the SSPs, will also be conducted, alongside a quantitative analysis of completed patient-reported experience questionnaires. An economic analysis will calculate the costs of delivering PN. Discussion This feasibility study will be instrumental in deciding whether to conduct the first definitive trial of PN in BSS in England. If PN is subsequently shown to be cost-effective at increasing uptake of BSS, NHS policies could be modified to implement PN as a standard service. The results will be disseminated in peer-reviewed journals and at scientific conferences. Trial registration International Standard Randomised Controlled Trial Number, ISRCTN13314752 Electronic supplementary material The online version of this article (doi:10.1186/s40814-016-0093-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lesley M McGregor
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT UK
| | - Hanna Skrobanski
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT UK
| | - Hayley Miller
- Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Queen Elizabeth Avenue, Sheriff Hill, Gateshead, Tyne and Wear NE9 6SX UK
| | - Mary Ritchie
- Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Queen Elizabeth Avenue, Sheriff Hill, Gateshead, Tyne and Wear NE9 6SX UK
| | | | - Stephen Morris
- Department of Applied Health Research, University College London, London, WC1E 6BT UK
| | - Colin Rees
- South Tyneside NHS Foundation Trust, South Tyneside District Hospital, Harton Lane, South Shields, Tyne and Wear NE34 0PL UK
| | - Christian von Wagner
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT UK
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20
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Smith SG, Kobayashi LC, Wolf MS, Raine R, Wardle J, von Wagner C. The associations between objective numeracy and colorectal cancer screening knowledge, attitudes and defensive processing in a deprived community sample. J Health Psychol 2016; 21:1665-75. [PMID: 25512199 DOI: 10.1177/1359105314560919] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We examined associations between numeracy and sociocognitive factors associated with colorectal cancer screening uptake (n = 964). Nearly half (45.7%) of the respondents incorrectly answered a numeracy question (low numeracy). Low numeracy respondents were less knowledgeable about colorectal cancer (p < .001), less positive towards screening (emotional, p < .001 and practical, p = .001) and less likely to intend to participate in screening (p = .001). They also reported greater defensive processing of cancer information (p = .001). Sociocognitive factors fully mediated the relationship between numeracy and screening intention. Addressing numeracy issues may reduce inequalities in CRC screening participation, but communication strategies could be limited by the tendency process cancer information defensively.
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Affiliation(s)
- Samuel G Smith
- University College London, UK Queen Mary University of London, UK Northwestern University, USA
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21
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Wardle J, von Wagner C, Kralj-Hans I, Halloran SP, Smith SG, McGregor LM, Vart G, Howe R, Snowball J, Handley G, Logan RF, Rainbow S, Smith S, Thomas MC, Counsell N, Morris S, Duffy SW, Hackshaw A, Moss S, Atkin W, Raine R. Effects of evidence-based strategies to reduce the socioeconomic gradient of uptake in the English NHS Bowel Cancer Screening Programme (ASCEND): four cluster-randomised controlled trials. Lancet 2016; 387:751-9. [PMID: 26680217 PMCID: PMC4761689 DOI: 10.1016/s0140-6736(15)01154-x] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Uptake in the national colorectal cancer screening programme in England varies by socioeconomic status. We assessed four interventions aimed at reducing this gradient, with the intention of improving the health benefits of screening. METHODS All people eligible for screening (men and women aged 60-74 years) across England were included in four cluster-randomised trials. Randomisation was based on day of invitation. Each trial compared the standard information with the standard information plus the following supplementary interventions: trial 1 (November, 2012), a supplementary leaflet summarising the gist of the key information; trial 2 (March, 2012), a supplementary narrative leaflet describing people's stories; trial 3 (June, 2013), general practice endorsement of the programme on the invitation letter; and trial 4 (July-August, 2013) an enhanced reminder letter with a banner that reiterated the screening offer. Socioeconomic status was defined by the Index of Multiple Deprivation score for each home address. The primary outcome was the socioeconomic status gradient in uptake across deprivation quintiles. This study is registered, number ISRCTN74121020. FINDINGS As all four trials were embedded in the screening programme, loss to follow-up was minimal (less than 0·5%). Trials 1 (n=163,525) and 2 (n=150,417) showed no effects on the socioeconomic gradient of uptake or overall uptake. Trial 3 (n=265 434) showed no effect on the socioeconomic gradient but was associated with increased overall uptake (adjusted odds ratio [OR] 1·07, 95% CI 1·04-1·10, p<0·0001). In trial 4 (n=168 480) a significant interaction was seen with socioeconomic status gradient (p=0·005), with a stronger effect in the most deprived quintile (adjusted OR 1·11, 95% CI 1·04-1·20, p=0·003) than in the least deprived (1·00, 0·94-1·06, p=0·98). Overall uptake was also increased (1·07, 1·03-1·11, p=0·001). INTERPRETATION Of four evidence-based interventions, the enhanced reminder letter reduced the socioeconomic gradient in screening uptake, but further reducing inequalities in screening uptake through written materials alone will be challenging. FUNDING National Institute for Health Research.
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Affiliation(s)
- Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Christian von Wagner
- Department of Epidemiology and Public Health, University College London, London, UK.
| | - Ines Kralj-Hans
- Department of Biostatistics, King's Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stephen P Halloran
- NHS Bowel Cancer Screening Programme Southern Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK; Royal Surrey County Hospital NHS Foundation Trust, Guildford, and University of Surrey, Guildford, UK
| | - Samuel G Smith
- Department of Epidemiology and Public Health, University College London, London, UK; Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Lesley M McGregor
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Gemma Vart
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Rosemary Howe
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Julia Snowball
- NHS Bowel Cancer Screening Programme Southern Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK
| | - Graham Handley
- NHS Bowel Cancer Screening Programme North East Hub, Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, UK
| | - Richard F Logan
- NHS Bowel Cancer Screening Programme Eastern Hub, Nottingham University Hospitals, Nottingham, UK
| | - Sandra Rainbow
- NHS Bowel Cancer Screening Hub, London Hub, Northwick Park and St Mark's Hospital, Harrow, Middlesex, UK
| | - Steve Smith
- NHS Bowel Cancer Screening Programme Midlands and North West Hub, University Hospitals Coventry and Warwickshire NHS Trust, Hospital of St Cross, Rugby, UK
| | - Mary C Thomas
- Department of Applied Health Research, University College London, London, UK
| | - Nicholas Counsell
- Cancer Research Centre UK and University College London Cancer Trials Centre, University College London, London, UK
| | - Steve Morris
- Department of Applied Health Research, University College London, London, UK
| | - Stephen W Duffy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Allan Hackshaw
- Cancer Research Centre UK and University College London Cancer Trials Centre, University College London, London, UK
| | - Sue Moss
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Wendy Atkin
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
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22
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Smith SG, Curtis LM, O'Conor R, Federman AD, Wolf MS. ABCs or 123s? The independent contributions of literacy and numeracy skills on health task performance among older adults. PATIENT EDUCATION AND COUNSELING 2015; 98:991-7. [PMID: 25936579 PMCID: PMC4468001 DOI: 10.1016/j.pec.2015.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 02/13/2015] [Accepted: 04/12/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the relationship between literacy and numeracy and their association with health task performance. METHODS Older adults (n=304) completed commonly used measures of literacy and numeracy. Single factor literacy and numeracy scores were calculated and used to predict performance on an established set of health self-management tasks, including: (i) responding to spoken information; (ii) comprehension of print and (iii) multimedia information; and (iv) organizing and dosing medication. Total and sub-scale scores were calculated. RESULTS Literacy and numeracy measures were highly correlated (rs=0.68; ps<0.001). In multivariable models adjusted for age, gender, race, education, and comorbidity, lower literacy (β=0.44, p<0.001) and numeracy (β=0.44, p<0.001) were independently associated with worse overall task performance and all sub-scales (literacy range, β=0.23-0.45, ps<0.001; numeracy range, β=0.31-0.41, ps<0.001). Multivariable analyses with both constructs entered explained more variance in overall health task performance compared with separate literacy and numeracy models (8.2% and 10% respectively, ps<0.001). CONCLUSION Literacy and numeracy were highly correlated, but independent predictors of health task performance. These skill sets are complementary and both are important for health self-management. PRACTICE IMPLICATIONS Self-management interventions may be more effective if they consider both literacy and numeracy skills rather than focusing on one specific ability.
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Affiliation(s)
- Samuel G Smith
- Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, USA; Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
| | - Laura M Curtis
- Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, USA
| | - Rachel O'Conor
- Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, USA
| | - Alex D Federman
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, USA
| | - Michael S Wolf
- Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, USA; Department of Learning Sciences, Northwestern University, Chicago, USA
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Smith SG, Raine R, Obichere A, Wolf MS, Wardle J, von Wagner C. The effect of a supplementary ('Gist-based') information leaflet on colorectal cancer knowledge and screening intention: a randomized controlled trial. J Behav Med 2014; 38:261-72. [PMID: 25253443 PMCID: PMC4353886 DOI: 10.1007/s10865-014-9596-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 08/30/2014] [Indexed: 01/22/2023]
Abstract
Guided by Fuzzy Trace Theory, this study examined the impact of a ‘Gist-based’ leaflet on colorectal cancer screening knowledge and intentions; and tested the interaction with participants’ numerical ability. Adults aged 45–59 years from four UK general practices were randomly assigned to receive standard information (‘The Facts’, n = 2,216) versus standard information plus ‘The Gist’ leaflet (Gist + Facts, n = 2,236). Questionnaires were returned by 964/4,452 individuals (22 %). 82 % of respondents reported having read the information, but those with poor numeracy were less likely (74 vs. 88 %, p < .001). The ‘Gist + Facts’ group were more likely to reach the criterion for adequate knowledge (95 vs. 91 %; p < .01), but this was not moderated by numeracy. Most respondents (98 %) intended to participate in screening, with no group differences and no interaction with numeracy. The improved levels of knowledge and self-reported reading suggest ‘The Gist’ leaflet may increase engagement with colorectal cancer screening, but ceiling effects reduced the likelihood that screening intentions would be affected.
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Affiliation(s)
- Samuel G Smith
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK,
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Kobayashi LC, Wardle J, von Wagner C. Limited health literacy is a barrier to colorectal cancer screening in England: evidence from the English Longitudinal Study of Ageing. Prev Med 2014; 61:100-5. [PMID: 24287122 PMCID: PMC3969575 DOI: 10.1016/j.ypmed.2013.11.012] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 11/14/2013] [Accepted: 11/15/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the association between health literacy and participation in publicly available colorectal cancer (CRC) screening in England using data from the English Longitudinal Study of Ageing (ELSA). METHODS ELSA is a population-based study of English adults aged ≥ 50 years. Health literacy, participation in the national CRC screening programme, and covariates were interview-assessed in 2010-11. All those age-eligible for screening from 2006 to 11 were included in the present analysis (n=3087). The association between health literacy and screening was estimated using multivariable-adjusted logistic regression. RESULTS 73% of participants had adequate health literacy skills. Screening uptake was 58% among those with adequate and 48% among those with limited health literacy skills. Having adequate health literacy was associated with greater odds of CRC screening (multivariable adjusted OR=1.20; 95% CI: 1.00-1.44), independent of other predictors of screening: age (OR=0.92; 95% CI: 0.91-0.94 per one year increase), female sex (OR=1.31; 95% CI: 1.11-1.54), and being in a higher wealth quintile (OR=1.88; 95% CI: 1.43-2.49). CONCLUSIONS Limited health literacy is a barrier to participation in England's national, publicly available CRC screening programme. Interventions should include appropriate design of information materials, provision of alternative support, and increased one-on-one interaction with health care professionals.
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Affiliation(s)
- Lindsay C Kobayashi
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK.
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK.
| | - Christian von Wagner
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK.
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Smith SG, Wolf MS, Obichere A, Raine R, Wardle J, von Wagner C. The development and testing of a brief ('gist-based') supplementary colorectal cancer screening information leaflet. PATIENT EDUCATION AND COUNSELING 2013; 93:619-25. [PMID: 24007765 PMCID: PMC3863947 DOI: 10.1016/j.pec.2013.08.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 07/25/2013] [Accepted: 08/11/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To design and user-test a 'gist-based' colorectal cancer screening information leaflet, which promotes comprehension of the screening offer. METHODS Twenty-eight individuals approaching screening age were recruited from organisations in deprived areas of England. Using a between-subjects design, we tested iterations of a newly-designed gist-based information leaflet. Participants read the leaflet and answered 8 'true' or 'false' comprehension statements. For the leaflet to be considered fit-for-purpose, all statements had to be answered correctly by at least 80% of participants in each round. Alterations were made if this threshold was not met and additional rounds of testing were undertaken. RESULTS At round 1, answers to 2/8 statements did not meet the threshold. After changes, answers in round 2 did not reach the threshold for 1/8 statements. In round 3, all answers were adequate and the leaflet was deemed fit-for-purpose. Qualitative data offered solutions such as language and layout changes which led to improved comprehension of the leaflet. CONCLUSION User-testing substantially improved the design and subsequent comprehensibility of a theory-driven gist-based colorectal cancer screening information leaflet. PRACTICAL IMPLICATIONS This leaflet will be evaluated as part of a large national randomised controlled trial designed to reduce socioeconomic inequalities in colorectal cancer screening participation.
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Affiliation(s)
- Samuel G Smith
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, London, UK.
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